The General Dental Council (GDC) 's executive director of regulation has said the organisation is prioritising improvements to support the mental health and wellbeing of dental professionals.

Speaking at the Canmore Trust Wellbeing Conference on November 8, 2024, Theresa Thorp presented a session on how the council seeks to address UK dental professionals' issues, focusing on the Fitness to Practise (FtP) procedure.

The conference brought together dental professionals, doctors, nurses and vets from across the UK to offer mutual support and learning about how to encourage wellbeing and prevent suicide.

Theresa began her session by providing an overview of the “GDC’s understanding of the pressures affecting dentistry, including the mental health of dental professionals”. She said that the council has been working on ways to “reduce the negative impact of regulation” but recognised that it still had “much more to do.”

The GDC’s understanding of the issues

Theresa explained that the “pressures within the NHS”, particularly concerning access to NHS dental services, are impacting the “wellbeing of patients and dental professionals.

“We know that the public report difficulties in booking appointments, in securing a dental practice to visit regularly, and having frequent cancellations, particularly affecting younger individuals, ethnic minorities, and urban residents. This inevitably creates pressure for the dental team too.

In June 2024, the council released the results of research into the experiences of early-career dental professionals. Commenting on the findings, Theresa said, “Although the majority felt well-prepared for practice when they first joined the register, dentists felt less prepared than dental nurses, hygienists and therapists, which is a concern.

“And dental professionals who have been registered for more than four years reported feeling less happy and more anxious than those who have been registered for less than one year. Dentists, particularly, said that they were least happy and most anxious.”

Theresa noted that across the overall dental sector, “those who work in it are experiencing a lot of pressure.”

To combat this, the GDC has committed “to learning and building” its understanding of “the issues that affect everyone in the dental sector”, including “the people who work in it and patients and the public who rely on their work.”

Theresa added that the council has pledged to understand more about the “impact of FtP upon registrants, informants and witnesses.”

The impact of FtP

Research from 2022, commissioned by the GDC and undertaken by Hull York Medical School, looked at registrants’ experiences of FtP proceedings.

The key findings showed that “while most of those who had participated in investigations or hearings perceived the outcome to be fair, they also told us that the process itself had negatively impacted their health, wellbeing, behaviour and practice.”

Theresa said, “We have also found that the ‘fear’ of regulation driven specifically by experiences and perceptions of FtP impacts on registrants’ decision-making and practice, in a way that we are told contributes to what is known as defensive practise.”

In November 2024, the council published a first-of-its-kind report into “dental professionals who died while FtP concerns were investigated or remediated, between 2019 and 2022.”

Theresa said, “The report made clear that some individuals took their own lives while FtP concerns were being investigated or remediated.

“Any death by suicide is a tragedy. The impact on the health and wellbeing of dental professionals during what we know can be a difficult and stressful process is of deep concern to us.

“We recognise that the death of a dental professional that occurs while FtP concerns are investigated or remediated is the death of a person who was still very much in their working life, leaving behind loved ones, friends and colleagues. These are people who have died too young, which is in itself deeply sad, and we offer our condolences to the family, friends and colleagues of those who have passed away while facing an investigation or hearing.

“When a concern is raised and investigated, what we have also heard is that there’s a considerable impact on a dental professional’s family, friends and colleagues too, as well as on their own health. All of this compounds an already difficult situation.

“Without a shadow of a doubt, regulatory proceedings are a cause of stress for many people, but also the cause of FtP proceedings may itself be a challenging and complex set of factors. In addition to acknowledging that the GDC must do better, the GDC’s report serves as a call for everyone in the dental sector to reflect on the environment, systems and processes involved in being a dental professional.”

Improving the experience

Looking to the future, Theresa said that the GDC is “moving towards supporting positive professional practice and away from an enforcement culture.” The council aims to “help practitioners to avoid becoming subject to regulatory proceedings in the first place.”

The regulator plans to achieve this by “setting and assuring the standards for undergraduate education” and providing “guidance on the professional standards required throughout a dental professional’s career.”

Theresa added that the GDC wants to share what it has learned from FtP and wishes to “work with stakeholders to help dental professionals understand what is expected of them.”

The GDC’s ultimate goals within fitness to practice are:

  • “Get faster without compromising quality outcomes and
  • “Make sure the process is fair to witnesses and registrants.”

These goals have been set to serve the GDC’s “overarching objective, which is to protect the public”, commented Theresa.

“We are committed to making improvements, but delivering all the changes needed is likely to take some time. We are prioritising work with the aim of improving support for dental professionals during the process. We are also prioritising work to ensure we identify learning from any serious incidents that occur.”

Theresa went on to outline actions that the GDC has taken to further these goals:

  • Amendments to the publications and disclosures policy: This ensures that “allegations presented to the Interim Orders Committee are not shared publicly before there has been a determination by a practice committee.”
  • Mental health training: Caseworkers and managers in FtP have received specialist training to “help them identify those who may be in distress and signposting them to support earlier and more effectively.” Independent panellists and their legal advisers have also received the training.
  • Communications revisions: The council has adopted a “more empathetic tone and better signposting” in its standard communications.
  • Impact of investigations: Additional weight has been given to the impact of FtP investigations on health and wellbeing when it receives requests for voluntary removal.
  • Case management: The Hearings Service has updated its procedures to reduce administrative delays and “to improve timeliness of proceedings.”
  • Participant support officer: This role has been created to support “particularly unrepresented dental professionals, throughout the proceedings and during the hearing when asked to do so.”

Following a year-long pilot in November 2024, the GDC announced a “permanent change to how we assess single patient clinical practice concerns.” The change means clinical dental advisors can make an “early request for the patient records and give their opinion, as dental professionals, about the seriousness of the concern.”

Theresa explained, “One of our casework managers then reviews the case, and if the treatment is of an appropriate standard, can close it with no further action.

Actions that the GDC has stated it will consider for the future include:

  • Practical support: The council is looking at ways to improve support measures for registrants, informants and witnesses, including additional assistance for vulnerable witnesses.
  • Learning programme: An educational programme that would be available to “senior leaders and all staff involved in FtP.”
  • Mental health training: A programme which would train those dealing with FtP cases to ensure that mental health awareness is at the “forefront of our minds when dealing with cases.”

Early-stage remediation: The council is considering ways to encourage remediation so that professionals can present evidence of remediation if a case reaches the Case Examiner stage or beyond.

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